Provider Demographics
NPI:1720682461
Name:GIPSON, BROOKE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:GIPSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 TRAVIS PKWY
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8511
Mailing Address - Country:US
Mailing Address - Phone:501-837-9680
Mailing Address - Fax:
Practice Address - Street 1:3220 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9039
Practice Address - Country:US
Practice Address - Phone:501-837-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD14524OtherARKANSAS STATE BOARD OF PHARMACY